“People are still pondering the new criteria; they’re not quite sure if it’s an advancement or has further pushed the fibromyalgia issue backwards,” says Dr. Jain.
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Explore This IssueJuly 2011
Both Drs. Jain and Stanford noted that the tender point exam helped patients accept their diagnosis. “When I did a tender point exam, for some reason in patients’ minds, fibromyalgia was a more acceptable diagnosis,” says Dr. Stanford. “Many patients want a definitive test and the tender point exam met that need. Whereas with the new criteria, many patients ask, is there a blood test or something?” Although the 2010 criteria do require a physician examination, there is no longer a specific number of tender points required for a positive diagnosis.
However, Dr. Stanford has adapted to the new criteria by explaining to patients the lack of a definitive test for fibromyalgia. She communicates that the widespread pain index and symptom severity score is a good diagnostic tool with a high degree of overlap with the tender point exam. “Communicating the severity symptom scale to patients will be valuable in giving patients a sense of where their personal disease is over the course of management,” says Dr. Stanford.
Outside rheumatology, the revised criteria are perceived as lowering barriers to fibromyalgia diagnosis. Dr. Jain says, “while I am great fan of the tender point exam since it helped me differentiate fibromyalgia from other conditions, I disliked the tender point criteria because so few clinicians were actually doing it. With the elimination of the tender point criteria, perhaps more patients will get diagnosed with fibromyalgia.”
Dr. Stanford also experienced problems with how tender point examinations were performed. She notes, “I get many patients saying, ‘I had a tender point exam.’ When I perform the exam, they say ‘That’s not what my doctor did.’ ” The new criteria also eliminate the clinician struggle over patients who didn’t meet the full tender point criteria. Dr. Stanford says that, “we’re probably missing a lot of people because they just aren’t as tender and didn’t have the 11 points. The new criteria will capture these people.” The symptom severity score is viewed as the biggest advantage of the new criteria. “Many of my patients say, ‘I can deal with the pain, but it is the fatigue or the “fibro fog” that is unmanageable,’ ” says Dr. Stanford.
The revised fibromyalgia criteria are percolating into primary care. Dr. Stanford notes, “At meetings, I always push the new criteria for their friendliness to primary care. You don’t have to do this tender point exam that no one got trained … to do. Look at the numbers from the widespread pain index and symptom severity score; these numbers tell us there is fibromyalgia.” As the fibromyalgia criteria committee intended, Dr. Stanford sees the 2010 criteria as exactly the tool primary care needs to manage fibromyalgia. “Once the ACR 2010 fibromyalgia criteria become known to most physicians, it will be a very good tool. It’s exactly what primary care was looking for when it comes to diagnosing fibromyalgia.” the rheumatologist